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Immunosuppression after Liver Transplantation

Liver Unit Queen Elizabeth Hospital, J.M.Neuberger{at}bham.ac.uk

The purpose of immunosuppression is to prevent the recipient's immune system from destroying or damaging the graft. Immunosuppression aims to balance under-immunosuppression leading to graft rejection and over-immunosuppression leading to sepsis and malignancy. There have been comparatively few studies on which to base a rational approach to immunosuppression. The types of immunosuppressants are 1) purine analogues such as 6-mercaptopurine (6-MP), 2) inhibitors of inosine monophosphate dehydrogenase such as myciphenolate mofetil (MMF), 3) glucocorticoids such as prednisone, 4) calcineurin binding drugs such as cyclosporin and tacrolimus, 5) TOR inhibitors such as sirolimus, and 6) mono- and polyclonal antibodies. There are five phases in the management of immunosuppression: 1) induction, 2) maintenance, 3) treatment of acute rejection, 4) treatment of chronic rejection, and 5) withdrawal of immunosuppression. Immunosuppression is complicated by intercurrent infection, usually viral or tubucular, and by pregnancy, breast feeding, diabetes mellitus, and renal impairment.

Key Words: liver transplantation • calicineurin inhibitors • anti-CD3

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